Category Archives: Back Pain

Safety And Efficacy Of The Unique Opioid Buprenorphine For Chronic Pain Relief

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PainRelief.com Interview with:
Joseph V. Pergolizzi, Jr., M.D.
Co-Founder and Chief Operating OfficerNEMA Research Inc.

Joseph V. Pergolizzi, Jr., M.D. Co-Founder and Chief Operating OfficerNEMA Research Inc.

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Chronic low back pain (CLBP) is a leading cause of disability.

  • Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line analgesic options or mild CLBP; however, when certain patients with moderate to severe CLBP do not achieve adequate pain relief, opioids are considered as an add-on therapy. Unfortunately, most opioid analgesics have the potential for adverse effects, abuse, and diversion.
  • Buprenorphine buccal film (Belbuca®) is an opioid analgesic classified as a Schedule III controlled substance in the United States and is a partial μ-opioid receptor agonist.
  • Buprenorphine buccal film is a unique analgesic that is approved by the US Food and Drug Administration for use in patients with chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment for whom alternative treatment options are inadequate.
  • Two pivotal phase 3 clinical trials (Study 307, Clinical Trial ID NCT01675167, and Study 308, Clinical Trial ID NCT01633944) established the efficacy and safety profiles of buprenorphine buccal film.
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Back Pain in Elderly: Most Patients Do Not Receive Physical Therapy

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PainRelief.com Interview with:
Dan Ly MD MPP
Staff Physician, VA Boston Healthcare System
Ph.D. Candidate in Health Policy (Economics)
Harvard University

Dan Ly Ph.D. Candidate in Health Policy (Economics) Harvard University

PainRelief.com:  What is the background for this study?

Response: New low back pain is a common complaint in primary care clinics. Prior research examining care patterns up to 2010 and sampling individual visits has found increasing use of opioids and advanced imaging and decreasing use of NSAIDs during this time period.

However, because care is delivered longitudinally, this study examined the care delivered to patients for new low back pain over the course of the year, which allowed me to look at the timing and sequence of care.

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Acute Low Back Pain: Does Ibuprofen With or Without Acetaminophen offer Pain Relief?

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PainRelief.com Interview with:
Benjamin W. Friedman, MD, MS
Department of Emergency Medicine
Montefiore Medical Center, Albert Einstein College of Medicine
Bronx, NY, 10467

Benjamin W. Friedman, MD, MS Department of Emergency Medicine Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, 10467

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Low back pain is a highly prevalent problem that causes more than 2 million visits to American emergency departments annually. Nonsteroidal anti-inflammatory drugs are first line medical management of this ailment, but are only modestly effective. We conducted an RCT to determine if adding acetaminophen to nonsteroidal anti-inflammatory drugs could improve outcomes two days and seven days after an ED visit for low back pain. Unfortunately, acetaminophen did not improve this outcomes.

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Yoga and Physical Therapy Improved Sleep in Patients with Chronic Low Back Pain

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PainRelief.com Interview with:
Eric J. Roseen, DC, MSc
Assistant Professsor, Department of Family Medicine
Boston University School of Medicine and Boston Medical Center

Eric J. Roseen, DC, MSc Assistant Professsor, Department of Family Medicine Boston University School of Medicine and Boston Medical Center
Dr. Roseen

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications. Given the serious risks of combining pain and sleep medications, we evaluated the use of nonpharmacologic approaches to manage sleep quality in adults with chronic low back pain.

Our randomized controlled trial included 320 adults with chronic low back pain from predominantly low-income racially diverse neighborhoods of Boston. At the beginning of the study, over 90 percent of participants with cLBP reported poor sleep quality. Participants were randomly assigned one of three different therapies for cLBP: physical therapy (PT), weekly yoga, or reading educational materials. Our previous research showed that yoga and PT are similarly effective for lowering pain and improving physical function, and reduced the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.

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Chronic Back Pain and Headache Often Occur in Same Patient

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PainRelief.com Interview with:

Arani Vivekanantham, MBChB, MPhil
University of Warwick
University Hospitals Coventry and Warwickshire NHS Trust
Coventry, UK
Centre for Epidemiology Versus Arthritis
University of Manchester, Manchester, UK

ni Vivekanantham, MBChB, MPhil University of Warwick University Hospitals Coventry and Warwickshire NHS Trust Coventry, UK Centre for Epidemiology Versus Arthritis University of Manchester, Manchester, UK

PainRelief.com:  What is the background for this study?

Response: Around one in five people have persistent low back pain and one in thirty have chronic headaches. People with low back pain are usually managed by musculoskeletal services whilst those with headaches are typically treated by primary care doctors and neurologists. There may be particular challenges in treating people with both disorders because of the risk of medication overuse headache in people taking regular pain killers for back pain.

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Chronic Back and Knee Pain Relief: How Do Sham Procedures Compare to Surgery?

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MedicalResearch.com Interview with:

Wayne B Jonas MD

Wayne B Jonas MD

H&S Ventures
Samueli Integrative Health Programs

MedicalResearch.com:  What is the background for this study?

Response: The findings of this study are based on a systematic review of 25 randomized clinical trials evaluating surgical type interventions (open surgeries, arthroscopic, endoscopic, laparoscopic, heart catheterization, radiofrequency, laser, and other interventions) for chronic back and knee pain. In each study, researchers had also performed sham procedures on a control group where they replicated the invasive procedure by omitting the step believed to be therapeutically necessary. The purpose of this it to determine how much of the effects are due to the placebo response.

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Self-Administered Acupressure Studied for Chronic Low Back Pain Relief

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PainRelief.com Interview with:

Susan Murphy, Sc.D., O.T.R.
Associate Professor
Physical Medicine and Rehabilitation Department
Research Health Science Specialist
VA Ann Arbor Health Care System, GRECC

PainRelief.com:  What is the background for this study?

Response: Chronic low back pain is very common and affects quality of life by reducing the ability to carry out needed and valued activities. In addition, people with chronic low back pain tend to have other symptoms like fatigue, sleep disturbances, and depression. Medications are typically prescribed but have side effects, and in some cases, may increase the risk of abuse and addiction. Non-pharmacological treatments are an important part of chronic pain management and may reduce pain as well as other symptoms.

In this study, we examined the use of self-administered acupressure as a pain management strategy in people with chronic low back pain. Acupressure is a Traditional Chinese Medicine technique in which physical pressure is applied to specific points on the body. It is similar to acupuncture, but instead of needles, pressure is applied with a finger, thumb, or device. In previous studies, people with cancer-related or osteoarthritis pain who self-applied acupressure had reduced symptoms such as pain and fatigue.

PainRelief.com: What are the main findings?

Response: Our pilot randomized controlled trial involved 67 participants with chronic low back pain. They were randomized into one of three groups – relaxing acupressure, stimulating acupressure, or usual care. Participants in the acupressure groups were trained to apply pressure to specific anatomical points on their body, and asked to complete daily treatment sessions for 6 weeks. We found that people who performed stimulating acupressure had improved pain and fatigue, and people who performed relaxing acupressure had improved pain after 6 weeks compared to those in the usual care group. No differences among the groups were found for sleep quality or disability after 6 weeks. Participants performed an average of 85% of the daily acupressure sessions and there were minimal adverse events. Adverse events, such as skin breakdown, muscle spasm, and headache were attributed to applying too much pressure and adjustments in application technique was done to avoid future issues.

PainRelief.com: What should readers take away from your report?

Response: Self-administered acupressure shows some promising effects on pain and fatigue in people with chronic low back pain. It is a low cost and low risk symptom management strategy that people can adhere to.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: Because this was only a pilot study, larger studies are needed to support the effectiveness of this treatment for people with chronic low back pain.

Citation:

Susan Lynn Murphy, Richard Edmund Harris, Nahid Roonizi Keshavarzi, Suzanna Maria Zick, Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial, Pain Medicine, , pnz138, https://doi.org/10.1093/pm/pnz138

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Neck and Back Pain More Common in Diabetes

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PainRelief.com Interview with:

Manuela L. Ferreira PhD
Institute of Bone and Joint Research
The Kolling Institute, Sydney Medical School

Paulo H. Ferreira PhD
Musculoskeletal Health Research Group
Faculty of Health Sciences
University of Sydney, Sydney, NSW, Australia

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: One in four Australians experience back pain or neck pain. Diabetes is also a worldwide prevalent condition, and currently affects over 382 million people. These two diseases often co-exist and have very similar underlying mechanisms, such as obesity and physical inactivity. We were unsure whether having one condition would lead to developing the other, however.

We have found 11 studies published to date, and assessing the relation between back or neck pain and diabetes. The studies included over 165,000 participants published in the USA, Canada, Finland, Denmark, Iran and Spain.

When we pooled the results of these studies together, we observed that people with type 2 diabetes are 35% more likely to also have low back pain (compared to people without diabetes). The risk of having severe back pain symptoms in people with type 2 diabetes is 63% higher and the risk of having severe neck pain is almost 30% higher, than in people with no diabetes.  We could not identify, however, whether type 2 diabetes can lead to back or neck pain, and it is possible that the two conditions are associated via other underlying mechanisms such as obesity and physical inactivity.

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Early Physical Therapy Can Be Protective Against Chronic Opioid Use

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PainRelief.com Interview with:

Steven Z. George, PT, PhD  Professor Director of Musculoskeletal Research Duke Clinical Research Institute Vice Chair of Clinical Research Orthopaedic Surgery

Dr. George

Steven Z. George, PT, PhD 
Professor
Director of Musculoskeletal Research
Duke Clinical Research Institute
Vice Chair of Clinical Research
Orthopaedic Surgery

PainRelief.com: What is the background for this study? What are the main findings?Response: This study adds to existing health services research investigating the sequence of services/providers for musculoskeletal pain and its impact on opioid use.

The study suggest that early physical therapy (PT) for the 4 most common musculoskeletal conditions (back, neck, shoulder, and knee) can be protective of chronic/long term opioid use for individuals that were opioid naïve when presenting for their care.  What is different about this study is that the 4 conditions were studied in the same cohort and the same definition of early PT was used (many of the previous studies just looked at 1 conditions, and used different definitions of early physical therapy).  The other thing that was different is that we used a larger dataset of private insurance providers, so this study cuts across different regions of the study (many of the previous studies included one health system).

There was notable consistency in the findings for the 4 conditions and protection of any opioid use, but there were some contingencies.

First was that there was no benefit on decreased dosage for individuals with neck pain – as that was not expected.

Second was that in a follow up sensitivity analysis it looked like the largest benefit of early physical therapy may be for those with back and knee pain.  Continue reading →

SEAL Procedure Gives Pain Relief To Some After Failed Back Surgery

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MedicalResearch.com Interview with:
"Personal Injury Back Pain" by SanDiego PersonalInjuryAttorney is licensed under CC BY-SA 2.0
Michael Perloff, MD PhD
Assistant Professor of Neurology
Interventional Pain Management
Boston University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Low back pain is very common. Patients with chronic low back pain that does not benefit from physical therapy, medications, or injections, often get spine surgery. If surgery fails to help (Failed back surgery syndrome-i.e. continued low back and leg pain after surgery), options for pain relief become more complex.

Typically, patients with failed low back surgery syndrome have tried complex procedures, repeat surgery or technology implants as their main options.

The SEAL procedure is a shortened, simple procedure (done in about 20 minutes) that can help as treatment for failed back surgery symptoms. In the published case series of 30 patients, some patients achieved very good, sustained, pain relief. Continue reading →